Clinical Practice in India- Equivalent to Corporate Sufism
Dr. Radhika Shrivastava is a practicing physician specialized in Public Health since past 20 years and contributed immensely in the field of maternal & child health. She has been associated with different national & international NGOs as a Technical consultant, for past 16 years like PSI,PCI,SIFSA,EngenderHealth,IPAS, PHDCCI, IIHMR &Medica Synergie. She is a recipient of Senior Research Fellowship of ICMR and International fellowship of Health technology assessment (HTA) & done six sigma Green belt. She has published many papers and articles in different National & International journals. She has done different Public health projects of Govt. of India as PI and Co-PI, in different parts of India.
Background: Clinical Practice is an amalgam of leadership, managerial skills, decision making, innovation along with empathetic attitude, which is what we call “Sufism”in ancient literature. Considering the demand of time, a practicing clinician, who is now called “Health care Provider”, dealing with so called “ Clients or Consumers” instead of patients. Evidence based medication has taken over experience and bed side knowledge, which is again directing amateur medical professional for didactic knowledge more than practicum. This article is all about dynamics of present day clinical practice and its challenges with shift in the scenario from Indian traditional system to western corporate & market based approach. The purpose is to make budding Clinician aware and bring understanding with respect to Indian value systems, resource settings and present health indicators (IMR, MMR) of India
Introduction
Clinical practice is the process by which a clinician is treating a client (patient) independently or in group, with their best of knowledge and experiences considering clinical guidelines, ethics and evidence based treatment. It has been existing in Indian context since beginning of medical sciences as vaid, hakeem or allopathic doctor (angrazi davakhana) . During earlier days even Govt hospital used to allow private practice by their doctors after hospital hours,legally (still existing in few states of India). Doctors were healers and their patient used to treat them equal to God. Faith and trust were the binding forces for doctor patient relationship. Until, the law brought the awareness about the doctor as providers and patient as consumer. Health care services are market driven so as to survive in this competitive world.
Data reveals that 70% of health care services are provided by private health care providers, in India. And these private health care providers are actually sharing the burden of Government, who isfalling short in providing these quality services, timely to their people. Vis a Vis, clinical practice is actually the strong pillar support, to the health care system of India where there is poor doctor patient ratio.
Keeping in view of present status of medical education with lack of campus placement and limitation of seats for Post- graduation, by default many medical professionals start their own clinical practice. A medical student who comes out fresh aftergraduation has no road map for their future usage. It all begins with a thought or compulsion or by choice or lack of alternative. As the processes of clinical practice are yet to develop, this article attempts to ensure the vision and mission.
Discussion
There is not much work done with respect to guiding a clinician for understanding the dynamics of establishing clinical practice. Many laws are made to keep
check on wrong practices but there is not much support given to how to provide quality services to the people through the upcoming project. These knowledge gaps and its repercussions are upsetting to not only clinicians but their patients also. An ill equipped doctor cannot manage the demands of today’s consumer hence;clinical practice needs a facelift, from Sufism to corporate culture.
Steps of Clinical Practice
STEP 1:
- Inception of project or Idea
- Bringing existence of clinic/ Hospital
- Staffing
- Reaching out to People/ Clients
Steps 2:
- Treatment modalities (clinical decision making & quality treatment)
- Stakeholders like Pharmacy, Lab, counsellors, dieticians, paramedical staff
Human resource management
Step 3:
- Data management
- Training & capacity building
STEP 4:
- Monitoring & evaluation
- Feedback & further progress
STEP 5:
- Sustainability of project
Challenges of clinical practices
• Lack of clear cut guidelines &road map
• Lack of support system
• Lack of knowledge of management of clinical practice
• Lack of knowledge of processes of managing a project
• Lack of knowledge of other departments (interdepartmental) like legal, financial & development sector
• Lack of goal, mission, vision and sustainability component
Way forward
- Practice management classes ( evening/ weekend)
- Capacity building of support staff
- Interlinking with Government goals
- Data collection and pooling in national data repository
- Join hands with government and non government sector
- Rebuilding faith through patients participation in decision making something like patient doctor association (PDA)
Conclusion
A medical student, who is interested in providing services through private practice, should be provided hand holding support after MBBS, as they can be the readily available human resource for the country where we are still struggling with TB, MMR and IMR. So, there is a need of management program for budding practicing clinician for serving their clients in a professional competent manner.
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